Breaking Through Denial

Low health literacy is widely recognized as a public health issue that affects access to care for people of all ages, races, and income levels. However, the stigma experienced by people with "diseases of denial"-such as erectile dysfunction (ED), HIV/AIDS, herpes, mental illness, and constipation-is an equally insidious, yet less tangible obstacle to seeking medical treatment. When low health literacy and denial coexist, the barriers to care can be overwhelming.

Diseases of denial can be broadly categorized as medical conditions that make patients feel excluded, rejected, devalued, inadequate, or guilty. Stigmatized patients often practice emotional subterfuge, which leaves them inert and powerless to address their medical conditions. An all-too-common scenario is for patients to convince themselves they don't have a "medical" condition, or that if they ignore their symptoms long enough, the condition will go away on its own. That's one reason pharma marketers should facilitate undiagnosed or untreated patients' self-identification and encourage them to communicate with healthcare providers about treatment options.

Inform and Empower
The key to motivating patients is understanding the emotions that fuel denial and counteracting them with tailored tools and messages. One example is Lilly's current unbranded campaign for bipolar disorder, which urges patients to share the history of their manic experiences with their physicians to avoid misdiagnosis of unipolar depression.

By getting untreated individuals to recognize that they need help, pharma brand managers take the first step toward raising brand awareness. An appropriate and well designed strategy can simultaneously increase the rate of new prescriptions and foster adherence. In the best-case scenario, an enhanced product profile and increased profits will follow.

The guiding principle for developing consumer communications aimed at patients with diseases of denial is recognizing that patients are people, not medical conditions. Therefore, it is critical to define patients not by their medical condition but by their response to it: that is, by their ability to initiate a treatment plan with physician guidance and to successfully adhere to it. In that way, taking action becomes a patient's basis for increased self-esteem.

Change Behavior
Effective consumer communications targeted to patients with diseases of denial can

accelerate uptake and enhance brand success

help patients redefine themselves in a positive context

decrease the overall financial burden on the healthcare system caused by undertreated medical conditions.

Strategies for addressing diseases of denial should target both patients and physicians and employ a multi-pronged approach that includes advertising, medical education, in-office patient materials, direct mail, and physician training programs.

The goal is to make the first conversation between physicians and patients as productive and collaborative as possible. Over time, such interaction generates a positive dynamic that can drive brand awareness and increase new and repeat prescriptions.

Sensitive, tailored communications can help overcome denial. Recent research for a drug to treat erectile dysfunction (ED) revealed that men with ED became so preoccupied with the condition that it affected their daily lives. The brand research showed that the men felt dragged down, incomplete, and diminished as human beings.

Based on those findings, marketers developed an "ED permission slip" to aid in the destigmatization of ED and encourage the men to begin treatment. The technique-based on behavioral contracting that has been used successfully to increase treatment compliance in areas such as diabetes, drug and alcohol addiction, and cancer-positively affects commitment, which can lead to adherence, increased self-esteem, and improvement in ED-related symptoms. Through thoughtful, clear, sensitive communication, patients can transform diseases of denial into action plans for improved health that can ultimately improve pharma's product sales.